List all birth team members (names and roles):
Health History:
Please check any that apply. This helps your provider understand your specific needs.
Fetal Diagnosis (if applicable):
Other Health Concerns:
For each preference, select your level of interest. Hover over the info icon for more details.
Hospital Preferences:
Wear my own clothes
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
As few interruptions as possible
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Minimal vaginal/cervical exams
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Hydrate with clear liquids
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Eat or drink as permitted
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Saline lock (IV port, no tubing)
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Medical Monitoring:
Intermittent fetal monitoring
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Wireless/waterproof monitoring
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Environment & Atmosphere:
Dim lighting
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Aromatherapy
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Music
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Quiet environment
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Physical Comfort & Movement:
Birth ball
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Peanut ball
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Massage
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Hip squeeze and counterpressure
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Freedom to change positions
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Walking and movement
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Hydrotherapy:
Shower
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Tub or labor pool
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Hot and cold therapy
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Mental and Emotional Support:
Meditation and mindfulness
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Visualization
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Vocalization
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Breathing techniques
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Pain Medication:
Epidural
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Nitrous oxide (laughing gas)
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
IV pain medication
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
No pain medication
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
For each preference, select your level of interest. Hover over the info icon for details.
Freedom to push in different positions
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Delayed cord clamping
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Immediate skin-to-skin contact
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Protected golden hour
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
For each preference, select your level of interest. Hover over the info icon for details.
Delayed first bath (24+ hours)
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Baby stays with me (rooming-in)
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Vitamin K injection
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Eye ointment
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Hepatitis B vaccine
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Lactation consultant visit
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Formula feeding support
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Photos and videos
i
Select preference...
Yes, I want this
I want to learn more
Not interested
Not available at my facility
Not possible due to health reasons
No preference
Any other thoughts, hopes, or preferences for your birth?